July 2020 Sign-ups

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* 1. Participant's name (first and last)

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* 2. Participant's age

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* 3. Does the participant have any disabilities, mental health disorders, or any other needs we should know about?

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* 4. Parent/guardian name(s) (first and last)

Name 1

Name 2

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* 5. Cell phone number(s)

Primary contact

Secondary contact

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* 6. E-mail address(es)

Primary contact

Secondary contact

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* 7. Do you have any of the following materials available to you?

Shakers (maracas, egg shakers or even Tupperware filled with rice or beans)

Tambourines or Jingle Sticks

Drums (or even a pot or plastic bin with a wooden spoon)

Jingle Bells

Rhythm Sticks (or two wooden spoons or rulers)

Xylophone

Other (please specify)

Online Group Options:
Visit http://www.infinitymusictherapy.com/classes-groups/ for full course descriptions
All groups are LIVE!

Let's Make Music! (for ages 3 months and up)
Offered Monday/ Wednesday 3:15pm-3:45pm
Dates: July 13, 15, 20, 22
Cost: $8/class or $30/4 classes

Sing and Sign (for families with children ages 3mos-5yrs)
Offered Tuesday/ Thursday 10:15am-11:00am
Dates: July 16, 21, 23, 28, 30
Cost: $10/class or $45/5 classes

Beginner Piano (ages 5yrs-12years)
Offered Monday/Wednesday from 2:00pm-2:45pm
Dates: July 15, 20, 22, 27, 29
Cost: $10/class or $45/5 classes
***You will need a keyboard or piano for this class. If you have questions about whether your equipment will work, please contact us.***

Rock Those Social Skills (for ages 7-13)
Offered Monday/ Friday from 4:00pm-4:45pm
Dates: July 17, 20, 24, 27, 31
Cost: $12/class or $50/5 classes

By submitting this form, I understand that I am agreeing to receive a text message from IvyPay to the provided number(s) in order to pay fees for services rendered. I will receive an email and text on how to sign into the group and other information upon processing a payment.

If you have any questions regarding this document, please contact Jona Jeffcoat, MT-BC, Director of services at jona@infinitymusictherapy.com or at (860) 518-5557.

Question Title

* 8. What dates are you registering for each class?

Let's Make Music

Sing and Sign

Beginner Piano

Rock Those Social Skills

July 2020 Sign-ups

Question Title

* 1. Participant's name (first and last)

Question Title

* 2. Participant's age

Question Title

* 3. Does the participant have any disabilities, mental health disorders, or any other needs we should know about?

Question Title

* 4. Parent/guardian name(s) (first and last)

Question Title

* 5. Cell phone number(s)

Question Title

* 6. E-mail address(es)

Question Title

* 7. Do you have any of the following materials available to you?

Question Title

* 8. What dates are you registering for each class?

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* 9. Please share any additional relevant information about the participant including favorite songs, artists, and other interests.